The Virtual Occupational Therapy Assistant (VOTA) will enable stroke patients to practice activities of daily living (ADLs) as part of an in-patient, skilled nursing, outpatient, home health, and/or teletherapy rehabilitation program. The system leverages low-cost human motion tracking, advanced kinematic pose estimation algorithms, and state-of-the-art game engine technology to create a compelling world in which patients can perform realistic virtual ADLs that challenge both motor and cognitive function. The system's advanced human motion tracking capabilities enable automatic generation of performance metrics, supporting both user feedback and remote monitoring of user status by providers. VOTA also comprises an OT Dashboard that lets therapists track progress, plan activities, and interact with patients. Problem to be addressed: VOTA provides a tool for upper extremity (UE) rehabilitation, potentially benefiting approximately three quarters of a million individuals in the United States who are affected by stroke each year. VOTA addresses critical challenges of: (1) improving outcomes by enabling increased dosage and intensity in physical practice, and promoting cortical reorganization based on physical practice and mental imagery; (2) reducing costs by decreasing the time and expense associated with patient/therapist travel; and (3) providing services to remote and underserved areas. Long-Term Goal: Improve stroke rehabilitation outcomes through effective and efficient delivery of care. Phase I Results: Phase I produced a VOTA prototype application that includes a compelling virtual world, two virtual ADL activities, and automated generation of motor and cognitive metrics. A pilot study was conducted at the University of Virginia-HealthSouth Rehabilitation Hospital in Charlottesville, VA that involved 10 stroke patients. Analysis confirmed the primary Phase I hypothesis that VOTA-generated metrics correlate significantly with accepted measures of UE motor function. Subjective inquiry through patient interviews and questionnaires strongly supports acceptance of VOTA by stroke survivors for clinical or home health use. Phase II Summary: In the proposed Phase II SBIR effort, the team will develop a VOTA application suitable for use as a stroke intervention, demonstrate the efficacy of virtual ADL therapy for UE motor recovery, and establish the usability of the VOTA system by patients and providers. Development will include an expanded breadth and depth of virtual activities, provider tools for patient monitoring and planning, activity authoring tools, improved motion tracking, and teletherapy interfaces. The effort will culminate in randomized, controlled trials to investigate VOTA efficacy, as measured by improvement in standardized assessment scores. Commercial Opportunity: Barron Associates, Inc. is uniquely positioned to rapidly commercialize this technology. Participation by HealthSouth, the nation's largest provider of rehabilitative healthcare services, provides a springboard for the introduction of VOTA therapy in clinical, home health, and teletherapy settings.